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ObjectiveTo compare the efficacy of enteral paracetamol and intravenous indomethacin for closure of patent ductus arteriosus (PDA) in preterm neonates.DesignRandomized controlled trial.SettingLevel III neonatal intensive care unit.Participants77 preterm neonates with birth weight ≤1500 g and PDA size ≥1.5 mm, with left to right ductal flow with left atrium to aortic root ratio >1.5:1; diagnosed by 2D-Echo within first 48 hours of life.InterventionParacetamol drops through the infant feeding tube (15mg/kg/dose 6 hourly for 7 days) or intravenous indomethacin (0.2 mg/kg/dose once daily for 3 days).Outcome measuresPrimary: PDA closure rate assessed by echocardiography. Secondary: need for surgical closure of PDA, renal impairment, gastrointestinal bleed, necrotising enterocolitis, hepatotoxicity, pulmonary hemorrhage, sepsis, hypothermia, retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia and mortality.ResultsPDA closure rate was 100% (36/36) in enteral paracetamol group as compared to 94.6% (35/37) in intravenous indomethacin group (P=0.13). The secondary outcomes were also similar between the two groups. There was no occurrence of hepatotoxicity.ConclusionsEnteral paracetamol is safe but not superior to intravenous indomethacin in the treatment of PDA in preterm neonates.

ObjectiveTo compare the efficacy of glycerin suppository versus no suppository in preterm very-low-birthweight neonates for improving feeding tolerance.DesignRandomized controlled trial.SettingLevel III neonatal unit from Mumbai, India.Participants50 very-low-birthweight (birth weight between 1000 to 1500 grams) preterm (gestational age between 28 to 32 weeks) neonates randomized to glycerine suppository (n=25) or no intervention (n=26).InterventionGlycerin suppository (1g) once a day from day-2 to day-14 of life or no suppository, along with intermittent oral feeds and standardized care.Primary outcomeTime required to achieve full enteral feeds (180 mL/kg/d).ResultsBaseline characteristics of neonates like gestational age, birth-weight, gender and age at the time of introduction of feeds were comparable in both groups. The mean (SD) duration to reach full enteral feed was 11.90 (3.1) days in glycerin suppository group and was not significantly different (P=0.58) from control group, [11.33 (3.57) days]. Glycerin suppository group regained birth weight 2 days earlier than control group but this difference was not significant (P=0.16). There was no significant difference in duration of hospital stay or occurrence of necrotizing enterocolitis amongst the two study groups.ConclusionOnce daily application of glycerin suppository does not accelerate the achievement of full feeds in preterm very-low-birthweight neonates.

Diagnostic and Statistical Manual of mental disorder-IV (DSM-IV) TR based INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) is an established instrument for the diagnosis of ASD in Indian subcontinent and low-middle income countries (LMIC). The introduction of DSM-5 necessitated revision of existing INDT-ASD tool to incorporate the DSM-5 related changes. This study was undertaken to develop and validate the DSM-5 based All India Institute of Medical Sciences (AIIMS)-Modified-INDT-ASD Tool. The modifications were done using Delphi method and included: (a) rearrangement of questions from the previous tool; and (b) addition of new questions on sensory symptoms. The modified tool was validated against DSM-5 diagnostic criteria. In addition, receiver operating characteristic (ROC) curves were used to determine the cut-off for total score as compared to Childhood Autism Rating Scale (CARS) score to grade the severity of ASD. Two-hundred-twenty-five children (159 boys, median age = 47months) were enrolled. The modified tool demonstrated sensitivity of 98.4% and specificity of 91.7% to diagnose ASD. A score ≥14 on the tool was suggestive of severe ASD (CARS>36.5) with a sensitivity and specificity of 80% and 80.7% respectively [Area under the curve = 0.89]. AIIMS-Modified-INDT-ASD Tool is a simple and structured instrument based on DSM-5 criteria which can facilitate diagnosis of ASD with acceptable diagnostic accuracy.

Background:Systemic sclerosis (SSc) treatment landscape has seen novel developments in the last decade in lung and skin domains of early disease. However, disease heterogeneity and fluctuating health infrastructure demand regional adaptation of high-quality trial data. We conducted a survey among Rheumatologists in India to assess the prevalent trends in managing systemic sclerosis.Objectives:•To explore the difference in trends in the assessment of Systemic sclerosis•To evaluate real-world trends in the treatment of different organ manifestations of SSc among rheumatologists in India.Methods:A questionnaire was designed by members of Indian Systemic Sclerosis Special Interest Group including a trial run, to assess the following aspects of SSc:•Disease trends- The frequency of organ-specific clinical features and the level of difficulty in treatment.•Assessment trends- The patterns of evaluation for organ involvement•Prescription trends- The practice pattern in the treatment of major SSc domainsThe survey was conducted in a bimodal manner. The Rheumatologists who attended a recent three-day national conference were invited to complete the questionnaire. Other practicing rheumatologists, including trainees, were contacted electronically and through local rheumatology networks to participate in the survey.Results:The participants in the survey were 210 (of 400 invited), with a response rate of 52.5%. Among them 30.5%(n=64) were trainees. Corporate hospitals were the most common practice setting (67.8%, n=129/190), 48% of responders worked in teaching hospitals. The most common source of patient referral was other specialists(n=186,97.4%), followed by self-referral (n=64,48.8%). A mean of 6 new patients per month were seen, with an annual follow-up of 68 patients per participant.The number of responses ranged from 195-206. The heterogeneity of SSc features encountered is summarized in Figure 1a. Puffy hands, arrhythmias, SIBO and constipation emerged as rare features. Calcinosis was the most difficult to treat(n=132/197,67%). Rectal incontinence was least targeted by participants (n=70/191, 36.6%). In disease assessment (Figure 1b), 55.7% agreed to recording mRSS; patient self-reported new areas of skin tightening (10%, n=21) and new skin symptoms (3.8%, n=8) were considered as worsening disease by those who did not perform mRSS. Utilization of NFC and endoscopy were less among the participants. Use of lung imaging, PFT and 6MWT were prevalent. 2DECHO with a focus on PASP and TAPSE was the most used for evaluation of pulmonary hypertension while Right heart catheterization and biomarkers were the least ordered.The treatment trends showed use of glucocorticoids by 82%; with majority prescribing less than 10 mg/day prednisolone equivalent (n=139, 66.1%) for 3 months or less (n=48, 22.8%) (Figure 2a). Most common indications for steroids were myositis (n=148, 34%), arthritis (n=141, 32.4%) and ILD (n=110, 25.3%). Early skin involvement, without other internal organ involvement was treated with immunosuppression (IS) by majority (n=179, 85.2%,) which was switched to another IS (n=149, 70.9%,) in the absence of improvement. Methotrexate (n=100, 47.6%) was preferred for skin tightening, with switching to rituximab (n=44, 20.9%). For ILD treatment, majority (99%) preferred Immunosuppression over antifibrotics, with 28.8% using it as add-on, preferably nintedanib, if ILD progresses. Mycophenolate was the most favored drug for ILD (62.6%, n=151 responses). In RP without gangrene, CCB with PDE5I addition upon worsening was the preferred strategy. For non-digital ulcers, steroids/DMARDs were most prescribed; an upfront combination of ERA+PDE5I was favored for PH by the majority. Pre-IS vaccination was favored by 90%.Conclusion:This nationwide survey to explore scleroderma practice trends among rheumatologists sheds light into domain-specific assessment and treatment preferences. Heterogeneity in disease encounter and practice patterns can significantly affect multicenter clinical trials and usage of outcome measures.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Dengue is a global epidemic causing over 100 million cases annually. The clinical symptoms range from mild fever to severe hemorrhage and shock, including some fatalities. The current paradigm is that these severe dengue cases occur mostly during secondary infections due to antibody-dependent enhancement after infection with a different dengue virus serotype. India has the highest dengue burden worldwide, but little is known about disease severity and its association with primary and secondary dengue infections. To address this issue, we examined 619 children with febrile dengue-confirmed infection from three hospitals in different regions of India. We classified primary and secondary infections based on IgM:IgG ratios using a dengue-specific enzyme-linked immunosorbent assay according to the World Health Organization guidelines. We found that primary dengue infections accounted for more than half of total clinical cases (344 of 619), severe dengue cases (112 of 202) and fatalities (5 of 7). Consistent with the classification based on binding antibody data, dengue neutralizing antibody titers were also significantly lower in primary infections compared to secondary infections ( P  ≤ 0.0001). Our findings question the currently widely held belief that severe dengue is associated predominantly with secondary infections and emphasizes the importance of developing vaccines or treatments to protect dengue-naive populations. In an analysis of severe dengue cases in a cohort of children in India, more than half could be attributed to primary rather than secondary infection, suggesting that primary dengue infections might also contribute substantially to severe disease burden.

An AlGaN/GaN MOS-HEMT (metal oxide semiconductor–high electron mobility transistor)-based dosimeter has been proposed to demonstrate and evaluate the impact of absorbed doses of radiations by virtue of interface trap charges at the interface of SiO2/AlGaN. The effect of various radiation doses induced (Nt = − 3 × 1012cm−2 to + 3 × 1012cm−2) has been studied in terms of various electrical parameters, such as channel conductance (gd), drain current (Ids), transconductance (gm), and threshold voltage(Vth). Variations in the drain current and channel potential, and a significant shift in the threshold voltage, have been observed. Threshold voltage and drain current increase proportionally to the radiation dose induced due to the addition of positive charges on the surface, leading to increased charge carrier concentration in two-dimensional electron gas (2DEG). Modifying the electron mobility/or density by the effects of induced radiation affects the functionality of the 2DEG-based device. The maximum changes in output conductance, drain current, threshold voltage change, drain-on sensitivity, and transconductance observed for the proposed sensor are 69%, 0.073 A, 593 mV, 0.314, and 0.018 S, respectively. The effects of variation in gate length on the threshold voltage sensitivity and sensor drain current have been studied.

In this manuscript, analog/RF performance, linearity, harmonic distortion, small signal AC performance and scattering parameter (S-parameters) metrics of gate-stack DM nanowire (NW) FET (4H-silicon carbide) have been critically examined with nanowire field effect transistor (NW FET) (silicon), nanowire (NW) field effect transistor (FET) (silicon carbide) and dual metal (DM) nanowire field effect transistor (NW FET) (silicon carbide). For a fair comparison, electrical characteristics like the majority and minority charge carrier concentration, energy and velocity in ON-State (V gs  = V ds  = 1.0 V) and OFF-State (V gs  = 0.0 V and V ds  = 1.0 V) have been evaluated. This paper combines the advantages of dielectric material having gate-stack HfO 2 (Hafnium oxide) with high-k and Al 2 O 3 (aluminium oxide) to attain a superior I on /I off ratio, intrinsic gain (g m /g d ), GFP (gain frequency product), GBWP (gain bandwidth product), TFP (transconductance frequency product), GTFP (gain transconductance frequency product), early voltage (V ea ), maximum frequency of oscillation (f max ), g m2 , g m3 (higher-order transconductances), UPG (unilateral power gain), maximum transducer power gain and delay. To check the relevancy of the device for RFIC applications, linearity assessment is performed by evaluating its several figure of merits like VIP 2 , voltage interception points (VIP 3 ), third-order intercept point (IIP 3 ), 1-dB compression point, third-order intermodulation distortion (IMD 3 ), HD 2 , HD 3 , harmonic distortions (THD) for all contemplated devices. Additionally, scattering parameters have been examined to affirm the small signal performance. This is being deduced further that our proposed device analysis exhibits improved electrical and linearity characteristics, and all of these factors contribute to its use in high-power and high-frequency implementation.

Awake fibre-optic intubation (AFOI) is an integral part of anaesthetic management of difficult airways. Conscious sedation is essential to assist AFOI. This study compared two different doses of dexmedetomidine in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation in patients undergoing elective cervical spine surgery with rigid cervical collar . A randomized, prospective, comparative study design was conducted in sixty patients divided into two groups: Group (L) ( = 30) patients received low dose of dexmedetomidine (0.5 μg/kg) along with airway blocks and Group (H) ( = 30) patients received standard dose of dexmedetomidine (1 μg/kg) along with airway blocks. Both the groups received dexmedetomidine infusion over 10 min followed by airway block. Quantitative data were analysed by applying Student's -test whereas qualitative data were analysed with Chi-square test. The objectives were to compare patients' Observer's Assessment of Alertness/Sedation scale (OAA/S) as primary outcome and other variables such as endoscopy, intubation condition, tolerance and haemodynamic stability among low and standard doses of dexmedetomidine. Group H had more favourable OAA/S score than that of Group L, but endoscopy and intubation time, patient tolerance, vocal cord and limb movement and satisfaction score did not differ significantly between the groups. There were no significant haemodynamic differences between the two groups. The 0.5 μg/kg dose of dexmedetomidine was found optimal and effective in combination with topical spray and airway blocks for awake orotracheal fibre-optic intubation for patients undergoing elective cervical spine surgery.

Background Earlier studies were focused on the genetics of temperate and tropical maize under drought. We identified genetic loci and their association with functional mechanisms in 240 accessions of subtropical maize using a high-density marker set under water stress. Results Out of 61 significant SNPs (11 were false-discovery-rate-corrected associations), identified across agronomic traits, models, and locations by subjecting the accessions to water stress at flowering stage, 48% were associated with drought-tolerant genes. Maize gene models revealed that SNPs mapped for agronomic traits were in fact associated with number of functional traits as follows: stomatal closure, 28; flowering, 15; root development, 5; detoxification, 4; and reduced water potential, 2. Interactions of these SNPS through the functional traits could lead to drought tolerance. The SNPs associated with ABA-dependent signalling pathways played a major role in the plant’s response to stress by regulating a series of functions including flowering, root development, auxin metabolism, guard cell functions, and scavenging reactive oxygen species (ROS). ABA signalling genes regulate flowering through epigenetic changes in stress-responsive genes. ROS generated by ABA signalling are reduced by the interplay between ethylene, ABA, and detoxification signalling transductions. Integration of ABA-signalling genes with auxin-inducible genes regulates root development which in turn, maintains the water balance by regulating electrochemical gradient in plant. Conclusions Several genes are directly or indirectly involved in the functioning of agronomic traits related to water stress. Genes involved in these crucial biological functions interacted significantly in order to maintain the primary as well as exclusive functions related to coping with water stress. SNPs associated with drought-tolerant genes involved in strategic biological functions will be useful to understand the mechanisms of drought tolerance in subtropical maize.